荟萃11-第十一章-泌尿系统疾病患儿的护理课件.ppt

1、Our greatest weak ness lies in giving up.The most certain way to succeed is always to try just one more time 肾病综合征患儿的护理肾病综合征患儿的护理Our greatest weak ness lies in giving up.The most certain way to succeed is always to try just one more time 小儿泌尿系统解剖生理特点?解剖特点肾脏：位置低输尿管：长而弯曲输尿管：长而弯曲膀胱：位置较高，容量小尿道：女婴尿道短，男婴尿

2、道长Our greatest weak ness lies in giving up.The most certain way to succeed is always to try just one more time?生理特点肾小球滤过率肾小管重吸收功能及排泄功能肾脏浓缩功能和稀释功能肾功能11.5岁时达成人水平小儿泌尿系统解剖生理特点Our greatest weak ness lies in giving up.The most certain way to succeed is always to try just one more time 正常少尿无尿ml/d ml/d ml/d

3、新生儿13 ml/(kg?h)?1 ml/(kg?h)?0.5 ml/(kg?h)婴儿400500?200幼儿500600?200?50ml/d 学龄前600800?300 学龄儿8001400?400?小儿排尿及尿液特点?排尿次数?每日尿量小儿泌尿系统解剖生理特点Our greatest weak ness lies in giving up.The most certain way to succeed is always to try just one more time?尿液特点淡黄色、透明pH值：57尿比重：1.0111.025蛋白：定性（-），定量100mg/24h 细胞：RBC

4、0?3/HP，WBC 0?5/HP 12小时Addis计数：?RBC50万，WBC 100万，管型5000，蛋白50mg小儿泌尿系统解剖生理特点Our greatest weak ness lies in giving up.The most certain way to succeed is always to try just one more time 肾病综合征（Nephrotic syndrome）?由于肾小球滤过膜对血浆蛋白的通透性增高，导致由于肾小球滤过膜对血浆蛋白的通透性增高，导致大量白蛋白自尿中丢失引起一系列病理生理改变的大量白蛋白自尿中丢失引起一系列病理生理改变的临床综合征

5、。临床综合征。Our greatest weak ness lies in giving up.The most certain way to succeed is always to try just one more time?病因：尚不十分清楚尚不十分清楚按病因分：?原发性?继发性?先天性按临床分：按临床分：?单纯性?肾炎性肾病综合征Our greatest weak ness lies in giving up.The most certain way to succeed is always to try just one more time?病理生理病理生理肾小球基底膜通透性大量蛋

6、白尿低蛋白血症肝脏合成脂蛋白高胆固醇血症血浆胶体渗透压循环血容量醛固酮ADH水钠潴留尿量水 肿液体转移至组织间隙肾病综合征Our greatest weak ness lies in giving up.The most certain way to succeed is always to try just one more time?临床表现单纯性肾病：单纯性肾病：?最常见的类型?27岁男孩多见?水肿：凹陷性水肿：凹陷性严重的全身性水肿严重的全身性水肿腹水、阴囊水肿皮肤有纹路?尿量减少，泡沫多尿量减少，泡沫多肾病综合征Our greatest weak ness lies in givin

7、g up.The most certain way to succeed is always to try just one more time 凹陷性水肿肾病综合征?临床表现Our greatest weak ness lies in giving up.The most certain way to succeed is always to try just one more time 阴囊水肿皮肤纹路?临床表现肾病综合征Our greatest weak ness lies in giving up.The most certain way to succeed is always to

8、 try just one more time?临床表现肾炎性肾病：肾炎性肾病：?年龄常在7岁以上，无性别差异?具有单纯性肾病的四大特征?高血压、血尿、氮质血症及补体低下高血压、血尿、氮质血症及补体低下肾病综合征Our greatest weak ness lies in giving up.The most certain way to succeed is always to try just one more time?并发症感染：最常见电解质紊乱高凝状态、血栓栓塞低血容量急性肾功能衰竭急性肾功能衰竭生长延迟肾病综合征Our greatest weak ness lies in givi

9、ng up.The most certain way to succeed is always to try just one more time?尿尿蛋白：?+?24 小时尿蛋白定量50mg/(kgd)红细胞：?见于肾炎性肾病?血液血液血浆总蛋白明显降低?白蛋白低于25g/L?白球比例倒置血胆固醇增高 5.72mmol/LC3补体下降尿素氮10.7mmol/L?见于肾炎性肾病肾病综合征Our greatest weak ness lies in giving up.The most certain way to succeed is always to try just one more t

10、ime 蛋白尿蛋白尿Our greatest weak ness lies in giving up.The most certain way to succeed is always to try just one more time?治疗一般治疗：一般治疗：?休息、饮食?感染的防治?利尿及降压三、肾病综合征Our greatest weak ness lies in giving up.The most certain way to succeed is always to try just one more time?治疗肾上腺皮质激素：首选药物肾上腺皮质激素：首选药物?诱导缓解阶段：足

11、量泼尼松2mg/(kgd),60mg/d分三次口服尿蛋白转阴后巩固两周，不少于4周，8周?巩固维持阶段：以原足量2天量的2/3，隔日晨顿服 4周，再逐渐减量?6个月为中疗程，9个月为长疗程三、肾病综合征Our greatest weak ness lies in giving up.The most certain way to succeed is always to try just one more time?治疗免疫抑制剂治疗：难治性肾病难治性肾病?环磷酰胺?环孢素A A抗凝治疗其他其他三、肾病综合征Our greatest weak ness lies in giving up.Th

12、e most certain way to succeed is always to try just one more time?常见护理诊断体液过多与低蛋白血症导致的水钠潴留有关营养失调：低于机体需要量与大量蛋白自尿中丢失有关有感染的危险与免疫力低下有关潜在并发症：药物副作用焦虑与病情反复及病程长有关三、肾病综合征Our greatest weak ness lies in giving up.The most certain way to succeed is always to try just one more time?护理措施休息休息?绝对卧床休息：严重水肿和高血压者?一般患儿定

13、时轻微活动?病情缓解36个月，可逐渐恢复就近上学，免体育活动三、肾病综合征Our greatest weak ness lies in giving up.The most certain way to succeed is always to try just one more time?护理措施饮食：低盐饮食饮食：低盐饮食?忌盐：水肿严重无尿及高血压者?适当限制水：高度水肿或少尿患儿?适当蛋白质：以1.2 1.8 g/(kgd)为宜?补充钙剂和维生素D?用激素期间应适当限制热量的摄入三、肾病综合征Our greatest weak ness lies in giving up.The mo

14、st certain way to succeed is always to try just one more time?护理措施预防感染预防感染?保护性隔离?皮肤护理?阴囊水肿的护理?注意无菌操作，避免肌内注射注意无菌操作，避免肌内注射?预防尿路感染?注意监测体温、血象三、肾病综合征Our greatest weak ness lies in giving up.The most certain way to succeed is always to try just one more time?护理措施观察药物疗效及副作用观察药物疗效及副作用?激素治疗期间注意激素治疗期间注意每日尿量、尿

15、蛋白变化及血浆蛋白恢复情况每日尿量、尿蛋白变化及血浆蛋白恢复情况?观察激素的副作用观察激素的副作用库兴氏综合征、高血压、骨质疏松、消化道溃疡等?观察免疫抑制剂的副作用观察免疫抑制剂的副作用注意白细胞下降、肝功能损害、脱发、胃肠反应、出血性膀胱炎及性腺的损害三、肾病综合征Our greatest weak ness lies in giving up.The most certain way to succeed is always to try just one more time?护理措施心理护理及健康教育心理护理及健康教育?关心爱护患儿?讲解激素治疗对本病的重要性?了解感染是本病最常见的合并症及复发的诱因?会用试纸监测尿蛋白的变化三、肾病综合征三、肾病综合征Our greatest weak ness lies in giving up.The most certain way to succeed is always to try just one more time